Posterior quadrant disconnection for refractory epilepsy: how I do it

Background Posterior quadrant disconnection (PQD) is intended to interrupt the propagation of intractable unilateral temporo-parieto-occipital epilepsy. Method An enhanced operative video presents the illustrative case of a total PQD indicated for a 15-year-old boy with Sturge-Weber syndrome suffering from seizure recurrence after a partial PQD. We describe the surgical procedure with emphasis on relevant anatomy and multimodal intraoperative guidance in three steps: (i) parieto-occipital disconnection, (ii) posterior callosotomy, and (iii) temporal disconnection/resection. Pearls and pitfalls of surgical management are discussed. Conclusion PQD is a less invasive surgical option to typical hemispherotomy and hemispherectomy for selected indications of posterior multilobar epilepsy.

Automated summary

This article presents the surgical procedure and management considerations of posterior quadrant disconnection (PQD) for the treatment of intractable unilateral temporo-parieto-occipital epilepsy. PQD is a less invasive surgical option for selected cases, offering potential benefits over typical hemispherotomy and hemispherectomy.